Late normalization of melanocytomalytic intraocular pressure elevation following excision of iris melanocytoma

Background: Melanocytoma of the iris is a rare tumor which may sometimes un dergo necrosis that could result in elevated intraocular pressure through p igment dispersion. Only nine similar patients have been previously reported . Methods: A 27-year-old woman presented with a dark brown iris stromal mas s located between the 4 and 8 o'clock positions in the inferior quadrant. H er left visual acuity was 20/60. The tumor encroached on the lens and cause d focal cataract. There was massive pigmented debris over the iridocorneal angle and the intraocular pressure was 42 mmHg. Results: Fine needle aspira tion biopsy did not suggest malignancy. A wide sector iridectomy was perfor med and histopathological examination of the lesion revealed melanocytoma o f the iris. There was no ciliary body involvement. In the post-operative pe riod, intraocular pressure, which persisted in the mid-twenties, was succes sfully lowered with topical dorzolamide and betaxolol drops. These drugs we re continued for 2 years while the angle pigmentation gradually disappeared . There has been no documented glaucomatous damage to the optic nerve and v isual fields. A year after the cessation of the drops, the left intraocular pressure stabilized and did not rise above 15 mmHg. Her left visual acuity remained 20/25. Conclusion: In contrast to previously reported cases, the normalization of intraocular pressure in this patient took 26 months, a per iod that could be associated with the self-clearing process of pigment from the iridocorneal angle. Close follow-up with medical treatment averted a p ressure lowering surgical procedure in this case.